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Re: Med-Checks/Insurance

Posted by Elaine on May 19, 1999, at 23:16:25

In reply to Re: Med-Checks/Insurance , posted by friend on May 19, 1999, at 12:55:47

Hi, I used to be with an HMO that covered mental health 50% up to 20 visits. Between weekly therapy sessions and periodic med checks with my pdoc, I far exceeded 20 visits in a year so I just used it as wisely as could, against the hour long therapy sessions rather than the 20 minute med checks. If you are forced into this restricted plan, the best you may be able to do is pay for your therapy and get whatever they will pay for med checks (having pdoc talk to you for 20-30 minutes so s/he can see if the medications are still appropriate). No medical plan is required to provide mental health benefits, my present one doesn't, but I don't understand how a referral service (and I'm not quite clear on how that works) can be more limiting than your actual health care provider. If they are being more restrictive (and do you have that in writing?), I might contact the Insurance Commissioner's office and check it out. You, your employer or whoever is paying the premium is paying for a certain amount of services, BY CONTRACT with the insurance company. I don't see how a referral service can legally step in and give you less than what you're paying for. I know why they do it - to show the insurance company how much they are saving in benefits - but I'm not sure of the legality, unless they're being sly and not putting it down as written policy. Anyway, my best suggestion is to check with the Office of the Insurance Commissioner, probably in your state capitol. Good luck!




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